Application for Employment


Name
Present Address
Permanent Address
Employment Questions

Are You Legally Eligible to Work in the United States?

Yes No

Are you 18 years of age or older?

Yes No

(Proof of your legal right to work in the US will be required after being hired)

Contact Information
Education Information

Years Completed:

1 2 3 4

Did you Graduate?

Yes No

Subjects, Studies and Degree Received:


Year Completed:

1 2 3 4

Did you Graduate?

Yes No

Subjects, Studies and Degree Received:


Year Completed:

1 2 3 4

Did you Graduate?

Yes No

Subjects, Studies and Degree Received:


Year Completed:

1 2 3 4

Did you Graduate?

Yes No

Subjects, Studies and Degree Received:

General

Subjects of Special Study or Research Work:


Job Related Training and Skills:

Employment Desired

(Office Positions are 1st Shift Monday through Friday)
(Please select only one shift)

Shift Preferred:

1st shift: M - Th
2nd shift: M - Th
1st shift: Fri, Sat, Sun
2nd shift: Fri, Sat, Sun

Type Desired:

Full Time Part Time

Are You Employed Now?

Yes No

If Yes, May We Inquire of Your Present Employer?

Yes No

Have You Ever Applied to this Company Before?

Yes No

Have You Ever Worked to this Company Before?

Yes No

EMPLOYMENT

List each Job held starting with your present or last job.
Job 1

Job Title and Duties


Job 2

Job Title and Duties


Job 3

Job Title and Duties


Job 4

Job Title and Duties


References

List the names of three people who you have known at least one year.(Do Not List Relatives)
Reference 1
Reference 2
Reference 3

AUTHORIZATION:

“I certify that the facts contained in this application (and accompanying resume, if any) are true and complete to the best of my knowledge. I understand that any false statement, omission, or misrepresentation on this application is sufficient cause for refusal to hire, or dismissal if I have been employed, no matter when discovered by the Company.
I authorize the Company to thoroughly investigate all statements contained in my application or resume, and I authorize my employers, former employers, and references to disclose information regarding my employment and character to the Company, without giving me prior notice of such disclosure. I release the Company, any employers, former employers, and all references listed above from any and all claims, demands, or liabilities arising out of or related to such investigation or disclosure.
In consideration of my employment I agree to conform to the Company’s rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause and with or without notice, at any time, at either my or the Company’s option. I also understand and agree that the Company may change the terms and condition of my employment, with or without cause and with or without notice at any time. I understand that no Company representative other than the President, and then only when in writing and signed by the President, has the authority to enter into any agreement for employment for any specific period of time or to make any agreement contrary to the foregoing.”